Nevada's Republican governor is 'all in' on ACA

Sandoval's embrace of Obamacare could hurt his national prospects. | AP Photo

States were supposed to run their own insurance exchanges but most GOP governors refused, forcing the feds to take on the job. Nevada is the only GOP-governed state running an exchange, although New Mexico Gov. Susana Martinez and Idaho’s Butch Otter are partnering with the feds this year and plan to run their own next year.

And once the Supreme Court made Obamacare’s Medicaid expansion optional at the state level, GOP governors split. Some high-profile ones like Rick Perry of Texas and Bobby Jindal of Louisiana have resisted. But at least eight Republican governors have also expanded Medicaid, including New Jersey’s Chris Christie, Arizona’s Jan Brewer, Michigan’s Rick Snyder and Ohio’s John Kasich.

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Recently, Nevada rejected the White House’s administrative “fix” that allowed the states to let insurers extend policies that would have been canceled next year because they don’t meet Obamacare standards. The insurance department said it couldn’t do that, and Sandoval said “the only way to fix the problems resulting from Obamacare is for Congress to change the law itself.”

Sandoval’s overall approach to carrying out the law harkens back to his earlier career. He was a U.S. district court judge in Nevada for four years before becoming governor. Earlier, he was the state’s attorney general.

“Especially when the Supreme Court engaged, it was at that moment — him being a man of the bench and a former attorney general — [Sandoval said] this is the law of the land and so we chose to go our separate way, which I think was wise,” said Nevada Lt. Gov. Brian Krolicki, also a Republican.

“You have to deal with how the table has been set and I call that leadership,” Krolicki added, noting that Sandoval had taken heat for some of his decisions.

Both Sandoval and Krolicki argued that running an exchange in the state ensures that Nevada — not Washington —will make key decisions that affect Nevadans.

“The various changes and federal mandates included in this law compelled us to make decisions for the state to best navigate the shortcomings and failures of this law,” Sandoval said.

Like other states, the Nevada exchange got off to a slow start but has since found its footing. As of Nov. 30, 4,834 residents had selected health plans through the exchange, according to the exchange.

But the state has a large pool of people eligible for coverage.Twenty-two percent of residents are uninsured, the second highest rate after Texas, according to the Kaiser Foundation. More than 36 percent of the state’s Hispanic population is uninsured — one of the highest rates among states with significant Hispanic populations. And getting them covered could help Republicans make inroads with that constituency.

Obamacare implementation so far has flown pretty far under the radar in Nevada, said Bob List, a former Republican governor of the state. Numerous polls and reports have found similar confusion and apprehension across the country.

“Everywhere I go I hear that ‘the president said I could keep my plan’ and ‘I know it’s going to cost a lot of money,’ And ‘I wish they’d repeal it,’” List said. “That’s the general attitude of the people of Nevada and I think that uncertainty about the consequences applies to the governor’s and legislature’s approach as well.”

List says Nevada’s high unemployment rate and steep Medicaid bills are taking a toll — two factors that he suspects went into Sandoval’s decisions.

“Our state’s been through a tremendous crunch and the cost of Medicaid in particular has just spiked,” he said. “So I think he’s looking to try to protect the taxpayers in Nevada.”